Hip
Adductor Tendon Injuries
What are the Adductor Tendons?
The adductor tendons are a group of tendons located in the inner thigh region of the upper legs. They are responsible for connecting the adductor muscles, which are a group of muscles that help bring the legs toward the midline of the body and rotate the thigh inward (internally rotate). These tendons play a crucial role in various movements, including walking, running, and maintaining balance. Adductor tendon and groin strain account for 5-6% of all sports injuries.
What is an adductor tendon injury?
Adductor tendon injuries refer to damage or overuse injuries that affect the adductor tendon group. Injuries to the adductor tendons can result in pain and discomfort in the groin area and may require medical attention and rehabilitation. Adductor tendon injuries can range in severity and may include conditions like adductor tendonitis, strains, or tears.
Adductor Tendonitis
Inflammation of the adductor tendon. It typically occurs due to repetitive stress or overuse of the adductor muscles and tendons. Symptoms include pain, tenderness, and swelling in the groin area.
Adductor Strains
Adductor muscles or their tendons are stretched or torn. This injury can range from mild to severe and is often characterized by sudden, sharp pain in the groin or inner thigh. It is common in athletes involved in sports that require quick changes in direction or explosive movements.
Adductor Tendon Tears
In severe cases, the adductor tendons can tear partially or completely. A complete tear is a more serious hip injury and may require surgical intervention.
What causes an adductor tendon injury?
An adductor tendon tear is caused by groin strain resulting from a sudden muscle contraction such as that which might accompany a quick change in direction, like pivoting, or a rapid acceleration, like sprinting. This can overstretch or tear the muscles.
The most common site of a hip adductor tendon injury is the junction between the adductor muscle and the adductor tendon. The adductor longus muscle is the most injured muscle, which pulls the leg toward the midline.
Groin and adductor tendon injuries are common in many sports such as ice hockey, soccer, football, tennis, gymnastics, ballet, rugby, wrestling, distance running, basketball, high-jump, and hurdling, and account for significant time off of play. Among all sports, adductor/groin strains are the most common injury accounting for almost 25% of all hip injuries.
Risk factors for adductor tendon injuries include a previous hip or groin injury, age, weak muscles, muscle fatigue, decreased range of motion, and inadequate stretching of the adductor muscles. Additionally, recent research suggests there is a genetic predisposition toward hip abnormalities that contribute to adductor tendon tears.
What are the symptoms of adductor tendon tear?
Adductor tendon injuries are graded according to their severity, and the symptoms can vary based off grade.
- Adductor Tendonitis: Groin pain, tenderness, and swelling in the groin area.
- Grade 1 Adductor Tendon Strain: Mild pain and tenderness but stretching and tearing are minimal.
- Grade 2 Adductor Tendon Strain: A partial thickness tear that causes pain, tenderness, bruising and muscle weakness.
- Grade 3 Adductor Tendon Tear: A severe tear with significant groin pain, bruising, loss of muscle strength, and loss of range of motion in the hip and thigh. In the most severe cases, the athlete may experience a snapping sensation when the tendon ruptures, and a complete loss of muscle function.
How is an adductor tendon injury diagnosed?
During your consultation with hip surgeon Dr. Bryan Penalosa, your medical history, adductor tendon symptoms, and past injuries will be reviewed.
Physical Exam
Dr. Penalosa will perform a physical examination of the hip and thigh, test muscle strength, and observe for bruising and swelling in case of more moderate and severe injuries.
Imaging
Initial hip x-ray imaging will help to evaluate the cause of pain and adductor strain and rule out other possible causes of groin pain. An MRI of the hip will show an increased signal at the site of the adductor tendon injury, a possible retracted adductor tendon if there is a full-thickness tear, and whether there is also an associated bony injury such as an avulsion fracture. An ultrasound may be employed to visualize the tendons, muscles, and ligaments in the pubic area.
Adductor Tendon Injuries Treatment Options
Can adductor tendon injuries be treated without surgery?
Most adductor tendon injuries are treated successfully without hip surgery. Non-operative treatment of adductor tendon injuries includes rest, icing, compression, elevation, anti-inflammatory medications, and after 48 hours, gentle stretching and strengthening exercises. However, progression depends upon pain. Physical therapy may be indicated. When necessary, Platelet Rich Plasma (PRP) injections under ultrasound guidance can improve the condition. PRP uses your own blood to create a concentrated solution of platelets to heal muscle strains. It is a minimally invasive procedure that may be recommended along with conservative measures to treat pain and facilitate quicker return to play in athletes with Grade 1 and 2 acute adductor tendon strains.
What are the surgical options for adductor tendon injuries?
A grade 3 tear such as a traumatic rupture of the adductor longus tendon may require hip surgery. When there is also an avulsion injury, meaning the tendon is torn along with a piece of bone, surgery to reattach the tendon (and bone) may be considered. Surgery may be recommended for active and professional athletes when conservative measures fail to relieve pain, or if time lost to conservative treatment is too costly to the athlete. The procedure involves reattaching the adductor tendon to the bone.
How long does it take to recover from an adductor tendon injury?
Generally, healing from a Grade 2 groin strain can take 3-6 weeks. Healing from a Grade 3 rupture can take up to 4 months.
What are the long-term effects of untreated adductor tendon injuries?
The best results are achieved when the adductor tendon injury is treated within 24 to 48 hours after injury. When left untreated, adductor tendon injuries can progress in severity.
How to prevent adductor tendon injuries?
Preventing adductor tendon injuries, especially for individuals involved in activities that place stress on the groin and inner thigh muscles, requires a combination of strategies to improve strength, flexibility, and biomechanics. Here are some tips to help prevent adductor tendon injuries:
Proper Warm-Up
Always start your physical activity with a thorough warm-up that includes dynamic stretching and mobility exercises for the hip and groin muscles. This helps prepare your adductor muscles and tendons for the demands of exercise.
Gradual Progression
Avoid overexertion and sudden increases in training intensity or volume. Gradually progress your workouts to allow your body to adapt and become stronger over time. Pay attention to any warning signs of discomfort or pain in the groin area. If you experience pain or discomfort, especially during physical activity, stop and seek medical advice if necessary.
Strengthening Exercises
Incorporate exercises that target the adductor muscles into your regular training routine. Focus on both the inner thigh and outer hip muscles to maintain muscle balance. Examples of exercises include leg adductions, lateral leg raises, and clamshells.
Core Strength
A strong core can help stabilize your pelvis and reduce strain on the adductor muscles. Include exercises that strengthen the abdominal and lower back muscles.
Flexibility
Perform regular stretching exercises to maintain flexibility in the hip and groin area. Incorporate static stretches and dynamic stretches to improve range of motion.
Proper Technique
Ensure that you are using proper form and technique during exercises and activities. Seek guidance from a coach or trainer if needed, especially for sports that involve quick changes in direction.
Footwear
Wear appropriate footwear for your sport or activity, as improper footwear can affect your biomechanics and lead to injuries.
Rest and Recovery
Allow your body sufficient time to recover between intense workouts or activities. Rest is crucial for muscle and tendon healing and adaptation.
Hydration and Nutrition
Stay well-hydrated and maintain a balanced diet to support muscle health and overall performance.
Cross-Training
Incorporate cross-training activities to reduce the risk of overuse injuries. Variety in your workouts can help prevent muscle imbalances.
Proper Rehabilitation
If you’ve had a previous adductor tendon injury, ensure that you complete a full rehabilitation program to regain strength and flexibility and reduce the risk of re-injury.